Provider Demographics
NPI:1013415611
Name:GIPSON, ABIGAIL J
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:J
Last Name:GIPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1620
Mailing Address - Country:US
Mailing Address - Phone:764-469-2909
Mailing Address - Fax:
Practice Address - Street 1:604 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1276
Practice Address - Country:US
Practice Address - Phone:260-982-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer